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==ABORTION==
2
AUTHOR Zieger W
AUTHOR Leveringhaus A
AUTHOR Pilch H
AUTHOR Wischnik A
AUTHOR Melchert F
TITLE [Uterine rupture during induced abortion with
prostaglandins in the second trimester]
SOURCE Geburtshilfe Frauenheilkd; VOL 55, ISS 10,
1995, P592-8 (REF: 43)
ABSTRACT Based on our own experiences and on the
literature of the past 14 years the variety
of the presenting symptoms in patients
suffering from ruptured uterus during the
second trimenon are discussed. focussing
especially on the first symptoms of a
so-called "silent" uterus rupture. A 41-year
old second gravida, first para--the healthy
full-term child was delivered by Caesarean
section--suffered a "silent" uterus rupture
after termination of pregnancy at 20th/21st
weeks' gestation. As more than 50 per cent of
patients with "silent" uterus rupture are
diagnosed with considerable delay, early and
repeated ultrasound examinations should be
performed in all patients with unexplained
symptoms or if despite abortion induction for
several days no progression of birth occurs.
In an artificially induced abortion,
prostaglandins should be topically applied to
enhance cervix ripening, preferably as a
biphasic treatment (first for cervix
ripening, later induction of contractions).
It is not yet clear whether a single or total
dose reduction of prostaglandins used in
labour induction in the second trimenon may
help to prevent uterus rupture in patients at
risk. Predisposing risk factors must be taken
into account before applying prostaglandins.
Uterus rupture should always be considered as
differential diagnosis if problems occur in
patients after induced abortion in the second
trimenon.
6
AUTHOR Hagay ZJ
AUTHOR Leiberman JR
AUTHOR Picard R
AUTHOR Katz M
TITLE Uterine rupture complicating midtrimester
abortion. A report of two cases.
SOURCE J Reprod Med; VOL 34, ISS 11, 1989, P912-6
(REF: 31)
ABSTRACT Uterine rupture occurring during a
midtrimester abortion is rare. This
complication may lead to profound shock and
death as well as to interference with the
patient's future fertility. Two patients
sustained a uterine rupture during
midtrimester abortion. This complication
seems to be preventable. The risk of uterine
rupture due to overstimulation is higher when
amnioinfusion with prostaglandin or
hypertonic saline is combined with the use of
other oxytocic drugs. Grand multiparas
undergoing amnioinfusion should not be given
oxytocin; in the rare cases in which oxytocin
is needed, it should be administered
cautiously and monitored continuously. When a
supplemental agent, such as an oxytocic, is
needed, it should not be started until
several hours after the amnioinfusion.
12
AUTHOR Bygdeman M
TITLE The use of prostaglandins and their analogues
for abortion.
SOURCE Clin Obstet Gynaecol; VOL 11, ISS 3, 1984,
P573-84 (REF: 38)
ABSTRACT In general, termination of second trimester
pregnancy is associated with three to five
times higher morbidity and mortality risks
than termination during the first trimester.
The procedures mainly used are extra- or
intra-amniotic administration of solutions
such as hypertonic saline, ethacridine
lactate, PGF2 alpha and PGE2. In comparison
with these procedures, the use of
prostaglandin analogues may offer important
advantages, the most important one being the
possibility of using non-invasive routes of
administration. The continuous development of
new analogues has now resulted in compounds
that are highly effective in stimulating
uterine contractility and are associated with
a low frequency of side-effects; these
compounds are suitable for both vaginal and
intramuscular administration and are
applicable for termination of pregnancy
during both the early and late parts of the
second trimester. The most widely used method
for termination of first trimester pregnancy
is vacuum aspiration. It is a highly
effective procedure and the overall
complication rate is low. One problem with
vacuum aspiration is the mechanical
dilatation of the cervical canal which is
necessary from at least the 8th week and
onwards. Pretreatment with laminaria tents or
with prostaglandin analogues eliminates or
reduces the need for mechanical dilatation
and significantly facilitates the procedure.
Pretreatment with prostaglandin analogues
also reduces the risk of both operative and
postoperative complications. The
prostaglandins also offer a possibility as a
non-surgical procedure for termination of
very early pregnancy. Both vaginal and
intramuscular administration of the latest
generation of PG analogues have been shown in
several studies to be equally as effective as
vacuum aspiration if the treatment is
restricted to the first three weeks following
the first missed menstrual period.
Gastrointestinal side-effects are still a
problem although of significantly less
importance than if natural prostaglandins are
used. Preliminary studies in which one of
these PGE analogues was administered by the
vaginal route indicate that
self-administration at home starts to be a
reality in selected patients.
8
AUTHOR Figueroa Damian R
AUTHOR Arredondo Garcia JL
TITLE [Current concepts in the pathogenesis and
treatment of abortion and septic shock. II.
The physiopathological bases and outlook in
the management of septic shock]
SOURCE Ginecol Obstet Mex 1993 Dec;61:337-43
ABSTRACT The septic shock has a low frequency in the
gynecologic-obstetric patients, nevertheless
several obstetric conditions like: septic
abortion, chorioamnionitis or puerperal
infections can be complicated with this
syndrome. The infections cause near 20% of
the maternal deaths. Because the high
morbidity and mortality of the patients with
septic shock is necessary to have an actual
knowledge of its pathogenesis and treatment.
Any person can be infected but only few of
them will develop a septic shock, the
response of the host to the microorganisms is
the critical point for the develop of this
syndrome. Many studies had showed the
importance of the bacterial endotoxin and the
tumoral necrosis factor as mediators of
septic shock. The treatment include: control
of the infectious process, restoration of
tissue perfusion pressure, restoration of
blood volume, use of inotropic agents and
general support measures. The role of
monoclonal antibodies against endotoxin in
the management of Gram-negative sepsis is
still ignored, but there are several studies
that support its use.
20
AUTHOR Huggins GR
AUTHOR Cullins VE
TITLE Fertility after contraception or abortion.
SOURCE Fertil Steril 1990 Oct;54(4):559-73
ABSTRACT There is a very small correlation, if any,
between the prior use of OCs and congenital
malformations, including Down's syndrome.
There are few, if any, recent reports on
masculinization of a female fetus born to a
mother who took an OC containing 1 mg of a
progestogen during early pregnancy. However,
patients suspected of being pregnant and who
are desirous of continuing that pregnancy
should not continue to take OCs, nor should
progestogen withdrawal pregnancy tests be
used. Concern still exists regarding the
occurrence of congenital abnormalities in
babies born to such women. The incidence of
postoperative infection after first trimester
therapeutic abortion in this country is low.
However, increasing numbers of women are
undergoing repeated pregnancy terminations,
and their risk for subsequent pelvic
infections may be multiplied with each
succeeding abortion. The incidence of
prematurity due to cervical incompetence or
surgical infertility after first trimester
pregnancy terminations is not increased
significantly. Asherman's syndrome may occur
after septic therapeutic abortion. The
pregnancy rate after treatment of this
syndrome is low. The return of menses and the
achievement of a pregnancy may be slightly
delayed after OCs are discontinued, but the
fertility rate is within the normal range by
1 year. The incidence of postpill amenorrhea
of greater than 6 months' duration is
probably less than 1%. The occurrence of the
syndrome does not seem to be related to
length of use or type of pill. Patients with
prior normal menses as well as those with
menstrual abnormalities before use of OCs may
develop this syndrome. Patients with normal
estrogen and gonadotropin levels usually
respond with return of menses and ovulation
when treated with clomiphene. The rate for
achievement of pregnancy is much lower than
that for patients with spontaneous return of
menses. The criteria for defining PID or for
categorizing its severity are diverse. The
incidence of PID is higher among IUD users
than among patients taking OCs or using a
barrier method. The excess risk of PID among
IUD users, with the exception of the first
few months after insertion, is related to
sexually transmitted diseases and not the
IUD. Women with no risk factors for sexually
transmitted diseases have little increased
risk of PID or infertility associated with
IUD use. There appears to be no increased
risk of congenital anomalies, altered sex
ratio, or early pregnancy loss among
spermicide users. All present methods of
contraception entail some risk to the
patient. The risk of imparied future
fertility with the use of any method appears
to be low.(ABSTRACT TRUNCATED AT 400 WORDS)
10
AUTHOR Apgar BS
AUTHOR Churgay CA
TITLE Spontaneous abortion.
SOURCE Prim Care 1993 Sep;20(3):621-7
ABSTRACT Spontaneous abortion rates vary with maternal
age, but the overall incidence is
approximately 2% of clinically recognized
pregnancies. The incidence of clinically
unrecognized loss is approximately 20%. Most
early fetal losses are caused by abnormal
karyotypes. Other causes include heavy
caffeine use, acute alcohol consumption, and
smoking. Ultrasonographic examination, which
includes yolk sac configuration and
crown-rump length determination can help
differentiate between normal and abnormal
pregnancies. After 8 weeks' gestation,
hormonal assays are decreased. Conservative
management of spontaneous abortions can be
considered if patients have low beta-hCG
levels and no residual tissue detected using
ultrasonography. Complications of spontaneous
abortion include maternal death, bleeding,
and infection. Consideration should be given
to the psychological health of women and
their partners who experience spontaneous
abortion, particularly if they exhibit
depression, guilt, and grief reactions.